Monthly Archives: July 2012

It’s Called the Graveyard Shift for a Reason

2012-07-30

People who work irregular schedules or work outside of normal daytime hours are at higher risk of heart attack, stroke, and other coronary events, according to a new study published this week in the British Medical Journal.

This study is not the first to show a link between shift work and heart health, but it is the largest-ever analysis of its kind. It pools together results from 34 previous studies on the topic, with a combined 2 million study participants from across the industrialized world, estimating that shift workers are at 23% greater risk of heart attacks than the other workers, 5% greater risk of ischemic stroke, and 24% greater risk of all coronary events combined (a category that includes heart attack but not stroke). Shift workers also had slightly higher overall death rates than average, but those results were not statistically significant.

Yoga Can Help Stroke Survivors Regain Their Balance

You don’t have to be a devoted yogi to reap the benefits of the cobra pose. A new study in chronic stroke survivors shows that practicing yoga can improve balance in patients, giving them more confidence to handle day-to-day activities and potentially reducing disability.

The study, published in the American Heart Association’s journal Stroke, involved 47 stroke survivors, mostly male veterans, who had had their stroke six months prior. The participants were still experiencing balance problems, which can be long-lasting after stroke, arising from injury to central brain structures and impaired senses. Difficulties with balance can lead to a higher risk of falls, further injury and continued disability.

Do Sports Products Really Enhance Your Workout? Maybe Not

2012-07-27

Do sports drinks really give your workout an extra edge? A recent study of the performance-enhancing claims of more than 100 fitness products says probably not. In fact, of the hundreds of such claims identified in product advertisements and websites, researchers couldn’t find a single one that was backed by solid scientific evidence.

For the study, researchers at the University of Oxford looked at advertisements for sports drinks, oral supplements, footwear, clothing and fitness devices like wristbands and compression sleeves in 100 general interest magazines and the top 10 sport and fitness magazines in the U.K. and the U.S. The team also searched the websites of any product making claims to enhance athletic performance or improve recovery, seeking references for scientific studies supporting these claims.

Alcohol Does a Body Good? Study Finds It Boosts Bone Health

2012-07-23

Just as the go-to drink for bone health — milk — has come under attack by New York Times’ food columnist Mark Bittman for not living up to its healthful reputation, a new study suggests an even more controversial beverage as an alternative: alcohol.

Previous research has linked moderate drinking with improved bone density — women who drink moderately have higher bone density than non-drinkers or heavy drinkers — but such observational studies connecting people’s dietary or drinking patterns to health effects have not been able to determine cause and effect. It’s possible, for example, that people who are healthier to begin with are more likely to drink moderately, rather than the other way around. However, experiments in animals that have been designed to show cause and effect have found that moderate doses of alcohol are indeed good for the bones.

Are men ‘sexually fluid’?

2012-07-20

In a new critically-acclaimed off-Broadway play, with a title too controversial for print, a gay man finds himself falling for a woman, which makes him – and his male partner – wonder whether he’s “really” gay after all.

Can a gay man who is sexually attracted to women still be gay? And what about straight men who get turned on by other men? Are men “sexually fluid”?

Female sexual fluidity – the capacity to move from romantic relationships with men to those with women, and vice versa – is well established, as I’ve previously discussed. Male sexual fluidity is less clear, yet it seems to be on the minds of many men and women. In fact, I’m often approached by women who are worried because they’ve caught their husbands or boyfriends looking at gay porn.

Lack of Exercise as Deadly as Smoking

When it comes to being couch potatoes, Americans aren’t alone. Physical inactivity has become a global pandemic, say researchers in a series of related papers published in the journal Lancet. According to one of the reports, lack of exercise causes as many as 1 in 10 premature deaths around the world each year — roughly as many as smoking.

About 5.3 million of the 57 million deaths worldwide in 2008 could be attributed to inactivity, the new report estimates, largely due to four major diseases: heart disease, Type 2 diabetes, breast cancer and colon cancer. The study finds that if physical inactivity could be reduced by just 10%, it could avert some 533,000 deaths a year; if reduced by 25%, 1.3 million deaths could be prevented. Say we got everyone off the couch and eliminated inactivity altogether: the life expectancy of the world’s population would rise by about 0.68 years (more, if you discount those who were already active), comparable to the effect of doing away with smoking or obesity.

For the study, led by I-Min Lee in the division of preventive medicine at Brigham and Women’s Hospital, scientists calculated something called a population attributable fraction (PAF), a measure of the contribution of risk factors like physical inactivity to diseases such as heart disease or diabetes, and even risk of death. The PAF told researchers how many cases of disease could theoretically be prevented if the risk factor were eliminated — that is, if all inactive people in a population were to start exercising sufficiently.

(MORE: Get Up! Sitting Less Can Add Years to Your Life)

Lee and his colleagues collected data on physical inactivity and outcomes of the four major diseases — heart disease, Type 2 diabetes, breast cancer and colon cancer — as well as rates for death from all causes. They then calculated PAFs for 123 countries. Overall, the estimates suggest that lack of exercise causes about 6% of heart disease, 7% of Type 2 diabetes, and 10% of breast and colon cancers worldwide.

Exercise has long been known to can lower risk factors like high blood pressure, high blood sugar and high cholesterol, which in turn reduces the risk of heart disease and diabetes. Physical activity also keeps heart vessels healthy and inhibits the formation of atherosclerotic plaques that can cause blood clots.

Current guidelines recommend that people get about 150 minutes of moderate exercise a week — a half-hour of brisk walking five times a week would do it. But in another Lancet paper published in the series, Pedro Hallal of the Federal University of Pelotas, in Brazil, and his colleagues found that 31% of adults worldwide (1.5 billion people) and 4 out of 5 teens aren’t exercising enough to meet that standard and therefore putting themselves at risk for chronic disease.

The researchers analyzed self-reports of exercise among adults in 122 countries, representing 89% of the world’s population, and among teens in 105 countries. Rates of physical inactivity were higher in high-income countries than in low-income nations. The Americas were overall the most sedentary region — with 43% of the population not exercising enough — while rates of inactivity were lowest in southeast Asia (17%).

One key reason is that we rely too much on modern conveniences like cars to get around. In the U.S., for example, fewer than 4% of people walk to work and fewer than 2% bike to commute; compare that to about 20% of people who walk to work in China, Germany and Sweden, and the more than 20% who bike their commutes in China, Denmark and the Netherlands, WebMD reports. Add to that the inordinate time most of us spend sitting — at the office, in front of the computer or watching TV.

Hallal estimates that sedentary people have a 20% to 30% greater risk of heart disease and diabetes than regular exercisers. But despite the deadly effects of lack of exercise, Hallal says physical activity doesn’t get the same attention or funding as other health risk factors. “It gets underfunded and undervalued,” Hallal told the Los Angeles Times. “But it’s huge everywhere in the world.”

(MORE: Long Commute? Your Heart and Waistline May Suffer for It)

There was some encouraging news in the results as well: thanks to greater awareness about the importance of physical activity in improving health, about 31% of adults do report engaging in vigorous exercise three or more days a week.

Another paper in the Lancet series also examined what kinds of interventions might help people get active. Researchers analyzed 100 reviews of clinical and community-based efforts to encourage exercise and found some simple strategies that seemed to work: using signs to motivate people to use the stairs instead of the elevator, for instance, or offering free exercise classes in public places such as parks, especially geared toward women, lower-income folks and the elderly, groups who are less likely to get the recommended amount of exercise. Studies from the U.S., Australia, Belgium, Canada, England and Germany indicate that maintaining streets and improving lighting can boost activity levels by as much as 50%.

The authors of the study pointed to a particularly effective program called Ciclovía, which started in Bogotá, Columbia, and has spread to 100 other cities in the Americas. On Sunday mornings and public holidays, the program closes city streets to motorized vehicles, leaving roadways open for walkers, runners, skaters and bikers. Ciclovía attracts about a million people each week, the study notes, mostly people on lower incomes, and accounts for 14% of people’s weekly recommended exercise.

(MORE: Extreme Workouts: When Exercise Does More Harm than Good)

Commenting on the Lancet series, many experts agreed that physical activity should be a global priority, though some took issue with the comparison with smoking. In an interview with WebMD, Timothy Armstrong, coordinator of the surveillance and population-based prevention program for the World Health Organization, noted that if the authors of the first paper had calculated the effects of smoking the same way they had for inactivity, the death statistics wouldn’t be quite so similar. Further, as Dr. Claire Knight of Cancer Research U.K. told the BBC, even if smoking and inactivity kill the same number of people, far fewer people smoke than are sedentary, making tobacco more risky to the individual.

Nevertheless, no one disagrees that the world population as a whole must start exercising more — and soon. “This is a super, super analysis,” Dr. James Levine, professor of medicine at the Mayo Clinic, told WebMD regarding Lee’s paper in the Lancet. “We know that as soon as somebody gets out of their chair, their blood sugar improves, their blood cholesterol and triglycerides improve, and that’s very consistent. Every time you get up it gets better. Every time you sit down it gets worse.”

The message, he says, is simple — get moving.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Early Marriages- a threat rather than child protection

2012-07-17

According to a study using data from 40 Demographic and Health Surveys, early marriages are most prevalent in Sub-Saharan Africa and South Asia. In Pakistan, the practice of early marriage or child marriage has been significant and has now taken shape of customary practices including that of ‘selling girls’ into marriage i.e. exchange marriages, whereby disputes are settled by exchange of the girls of the family. Even though both the sexes may be suffering from forced marriage in many cases, it is usually the girl who suffers the most.

The reason for this is that early marriage typically results in childbearing at a very young age. This poses great health risks for the girl and not being prepared for such a great responsibility so early in her life, she might go through immense psychological pressure. Although there are many repercussions of early marriage, this article particularly deals with the negative effects it has on the reproductive health of the girl.

These girls are faced with repeated pregnancies and unplanned babies, which results in a high number of abortions taking place. The impact of one abortion on the young girl is so traumatizing that she would rather choose not to have another baby. And to add to all of this, the inaccessibility to maternal and child health services and the issue of poverty in case the girl belongs to a poor family worsens things more for her! Most of the girls belonging to the rural areas are not even aware of contraception so they opt for abortions as the only resort, and when post-abortion complications arise they lack the awareness about the post-abortion care services that they can approach and avail. This sad situation results in numerous maternal deaths and poor health status among women.

In the case of early marriages, girls are not even mature enough to fight for their own rights or to speak for themselves-they feel that their husbands own them and if he wants more children then she has to bear them! However, even the Holy Quran tells us that nothing is more important than the woman’s health. If her health does not allow her to keep giving babies then it is simply not right for her to keep suffering. Some parents feel that if they get their child married at an early age they are protecting them. However, the fact is that this results in lost development opportunities, hinders personal growth and increases the chances of poor health and limits life options.

Restricted mobility of these girls, lack of intimacy with their husbands and lack of resources for counseling causes these young girls many internal problems. Motherhood is viewed by them as their sole purpose in life and they seem to have no life of their own. With her childhood already limited due to early marriage, she is burdened with the responsibility of handling a man whom she doesn’t even know that well and pregnancies that she is unable to handle. She has lost the joy of celebrating marriage which is the dream of every young girl-and all at the expense of her health!

It is high time that we realize the detrimental effects of early marriage on the girls in our society, and try to do our part in spreading awareness about the maternal and child health services, the sexual and reproductive counseling that we can make available to them and save their lives…we need to work towards eradication of the process of wasting productive lives in order for Pakistan to benefit from each individual born on its land-an asset we must save!

The author of the above blog is an ungrad student from Institute Of Business Administration, Karachi
Maham Sundus

2012-07-16

In April, the Food and Drug Administration (FDA) updated the warning to finasteride, Merck & Co.’s drug marketed to treat both male pattern baldness (Propecia) and enlarged prostate (Proscar). The new warnings noted that the sexual side effects associated with the medication, including problems with libido, ejaculations and orgasm, could last even after patients stop taking the drug.

Now a new study published in the Journal of Sexual Medicine finds that side effects may not only continue after stopping finasteride, but they may last for months or even years.

In the study, Dr. Michael Irwig of George Washington University and his colleagues surveyed 54 men under age 40 who reported experiencing side effects for three months or more after stopping the medication Propecia. The patients reported a variety of sexual problems including erectile dysfunction, low libido, trouble having an orgasm, and shrinking and painful genitals. Some men also reported neurological problems like depression, anxiety and cognitive haziness.

For 96% of the men, the sexual problems lasted more than a year after they quit using the drug. None of the men had sexual, medical or psychiatric complaints before taking Propecia.

The study sample was small and the authors acknowledge that it may be skewed to include only men who were most negatively impacted by the drug. Most of the participants were recruited through an Internet forum called Propeciahelp.com, for men experiencing persistent side effects.

Still, the authors argue their findings may signal potentially serious risks for men using finasteride. “Our findings make me suspicious that this drug may have done permanent damage to these men,” Irwig told ABC News.

The FDA’s updated warning labels for finasteride were based on a review of post-marketing reports of sexual dysfunction. The agency reviewed 421 post-marketing reports of sexual side effects related to Propecia from 1998 to 2011; out of these cases, 59 reported adverse sexual effects lasting over three months after discontinuing the drug. For Proscar, the FDA reviewed 131 cases of erectile dysfunction and 68 cases of decreased libido from 1992 to 2010. As Healthland reported in April:

Finasteride labels will now warn users that Propecia’s side effects can include libido disorders, ejaculation disorders, and orgasm disorders that continue after discontinuation of the drug and that Proscar can lead to decreased libido that continues after quitting the drug. Both medications will receive a new description of reports of male infertility and poor semen quality that normalized or improved after stopping therapy.

“Despite the fact that clear causal links between finasteride (Propecia and Proscar) and sexual adverse events have not been established, the cases suggest a broader range of adverse effects than previously reported in patients taking these drugs,” the FDA said in a statement.

(MORE: Study Finds Pattern in Male Baldness: Could There Be a Cure?)

Irwig acknowledges that the number of men experiencing long-lasting side effects from finasteride is small, although the incidence of sexual side effects in clinical trials was around 2%, the incidence of persistent sexual side effects is unknown, but likely less than 0.1%. “But because the medication is prescribed so commonly, it’s still a lot of people, likely several thousand men around the world,” Irwig told ABC News.

Both the FDA and Merck maintain that finasteride is safe and effective.

Does the Internet Really Make Everyone Crazy?

Sociologists call them moral panics — when a population pins its unanchored fear in uncertain times on a selected demon, whether or not the target is really a threat to society. Drugs are a frequent focus of these societal anxiety attacks, but this week, Newsweek tries to foment a classic panic against a more universal foe: the Internet.

Headlined online “Is the Web Driving Us Mad?” the article begins with the story of Jason Russell, the filmmaker behind the “Kony2012″ video about the African cult-leader and warlord Joseph Kony. After the video went viral and suddenly brought Russell international fame, he wound up naked and ranting on a San Diego street corner. To make the case that the Internet caused Russell’s psychotic break, the Newsweek article rapidly generalizes from rare, extreme experiences like Russell’s and wends through a selective reading of the research to argue, in the words of one quoted source, that the Net, “encourages — and even promotes — insanity.”

(MORE: The Internet Knows You’re Depressed, but Can It Help You?)

According to senior writer Tony Dokoupil:

The first good, peer-reviewed research is emerging, and the picture is much gloomier than the trumpet blasts of Web utopians have allowed. The current incarnation of the Internet—portable, social, accelerated, and all-pervasive—may be making us not just dumber or lonelier but more depressed and anxious, prone to obsessive-compulsive and attention-deficit disorders, even outright psychotic. Our digitized minds can scan like those of drug addicts, and normal people are breaking down in sad and seemingly new ways.

The problem is, this conclusion runs counter to what the research data actually show.

Dokoupil makes much of brain scan studies suggesting that Internet use “rewires” the brain in ways that look similar to changes seen in drug addiction. The reality is that any enjoyable activity leads to changes in the brain’s pleasure regions if a person engages in it frequently enough. Indeed, any activity we perform repeatedly will lead to brain changes: that’s known as learning. Riding a bicycle and playing the violin also rewire the brain, but we don’t choose to refer to these changes as “damage.”

As yet, there is no brain scan that can clearly determine whether certain brain changes signify addiction or simple, harmless enjoyment. Nor can brain scans predict, in the case of addiction, who will be able to regain control over their behavior and who will not.

(MORE: Hooked on Addiction: From Food to Drugs to Internet Porn)

Dokoupil cites a study that scanned 24 people, some experienced Web users and some who were less proficient. He says that the regular users had “fundamentally altered prefrontal cortexes,” but he fails to mention that the research only explored people’s Google use — comparing Google aficionados to newbies. He writes further that just five hours of time spent online (using Google) “rewired” the brains of the new users. This, of course, tells us nothing about addiction: we don’t know if the experienced Google searchers were even having trouble controlling their Internet use, or whether, based on one small study, a tiny bit of experience learning how to search the Web can “rewire” the brain dramatically. If so, then everyone’s addicted — or no one is, and the brain changes are meaningless.

Dokoupil acknowledges that the research linking Web and smartphone use to psychiatric problems cannot show clear cause and effect, but he brushes off this important caveat with quotes from experts who conduct this research and use it to confirm their own clinical observations — in other words, anecdotes, which are an even sketchier source of data — and make causal claims.

In truth, the research linking Internet use to addiction, depression or other behavioral and psychiatric problems simply cannot determine whether being online causes these ills or whether people who are already prone to such problems tend to go online more. In fact, there’s better evidence (not mentioned in the article) that the Internet can be used to treat anxiety and depression than there is suggesting it causes these problems. Randomized controlled trials of online therapy for depression have found it to be as effective as traditional therapy — and only randomized controlled trials, not the observational data cited by Newsweek, can scientifically demonstrate cause and effect.

(MORE: Study: Playing a Video Game Helps Teens Beat Depression)

Dokoupil also approvingly cites an expert who has become a target of widespread ridicule in the science blogosphere for her extreme claims about Internet-related brain damage. Baroness Susan Greenfield, a pharmacology professor at Oxford, told Dokoupil in her typically understated way that the Internet problem “is an issue as important and unprecedented as climate change.”

Greenfield has never published a study on Internet use. The logic behind her claims is often befuddling: for example, this is how she attempted to explain why she believes the Internet has something to do with the recent rise in autism, in a 2011 interview with the Guardian: “I point to the increase in autism and I point to Internet use. That’s all.” Obviously, that is not scientific reasoning, which is why her comments inspired an Internet meme (among other outrage and disdain) that trended on Twitter.

Dr. Ben Goldacre, a leading British science journalist and author of the “Bad Science” blog, sums up the criticisms of Greenfield this way: “[Her ideas] are never set out as a clear hypothesis, in a formal academic publication, with the accompanying evidence and a clear suggestion of what research programmes might be planned to clarify any uncertainties.”

The Newsweek feature also highlights stories from China, Taiwan and Korea, where Internet addiction has been accepted as a genuine psychiatric problem and treatment centers have been set up to deal with it. “Tens of millions of people (and as much as 30 percent of teens) are considered Internet-addicted” in these countries, Dokoupil writes.

Those facts, however, don’t necessarily mean that Internet addiction exists, let alone that it is widespread. Simply naming a disease and treating it doesn’t make it real, no more than the existence of witch hunts proves the existence of witches. Indeed, some of the treatments used for Internet addiction, such as the abusive Internet treatment boot camps in China where several teens have died, suggest how easily the cure can become worse than the disease when unproven therapies for ill-defined problems spring up. (Boot camps have never been shown to help with any form of addiction.)

(MORE: Blogging Helps Socially Awkward Teens)

In fact, while expanding the diagnoses for addiction overall, the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychiatry’s diagnostic manual, which will be published next year, rejected Internet addiction as a bona fide disorder. The Newsweek article spun this fact, highlighting instead that Internet addiction “will be included for the first time, albeit in an appendix tagged for “further study.’”

The truth is, we really don’t know much about how our online lives are affecting us. It’s quite possible that Internet use has the deleterious effects critics suggest — certainly some people do have difficulty controlling the amount of time they spend online. But is it the addictive effect of the Internet that keeps us checking our work emails on vacation or during evenings and weekends — or is it the fact that we fear we may lose our jobs if we don’t?

The Internet might indeed be a cause of our societal worries, but not necessarily because we’re addicted to it. And creating a moral panic based on flimsy evidence isn’t going to help, no matter what the real cause of our problems.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.

Sexonomics: Putting your ‘erotic capital’ to work

2012-07-13

Madonna’s got it. So do George Clooney, Tina Turner and Robert Redford.

These celebrities are certainly good-looking, but they also possess what sociologist Catherine Hakim has dubbed “erotic capital” – a term that describes a certain je ne sais quoi that includes, but isn’t limited to, sexual attractiveness.

Harness your erotic capital, Hakim boldly suggests in her recent book by the same name and you’ve got the potential to not only land a mate, but to get ahead at work and in society as a whole.

Sociologists and economists have long recognized three main types of capital: social, economic and cultural. Your capital depends on the assets and resources you can potentially use for gain, whether that means making more money or making more friends. But we’re neglecting a fourth important kind of capital, Hakim argues.

By her definition, erotic capital is more than just good looks and has six main facets:

1. Beauty

2. Sexual attractiveness

3. Social skills/likeability

4. Liveliness

5. Style

6. Sexual competence

While one of these characteristics might make you gorgeous or funny or fun, you need the whole group to maximize erotic capital. And you don’t have to be born with it – erotic capital is cultivated and learned and has a lot to do with your self-esteem.

Even if you’ve got “it” you might not be capitalizing on it. Hakim says women have more erotic capital than men do — and that they should be exploiting it more as a result.

She bases this idea partly on studies that suggest that men tend to have stronger libidos than women.

“Men’s demand for sexual activity and erotic entertainment of all kinds greatly exceeds women’s interest in sex,” Hakim writes. In this line of thinking, sex has a market value, and women have the potential to leverage their ability to supply men’s demand for it.

I find this theory interesting, although I certainly don’t agree with it fully. As I’ve discussed in an earlier column on low male libido, there are plenty of couples in which the woman wants more sex and is coping with a male partner who has a low sex drive. And as the recent frenzy for the erotic trilogy “Fifty Shades of Grey” makes clear, women have a voracious appetite for sexual entertainment.

At the same time, we live in a culture that has become increasingly centered around sex. Many women already feel as if they need to compete with porn stars, strippers and celebrity sex tapes for male attention. Are we really suggesting that society needs more of this, not less?

Just as sexism still exists, so too does “looksism.” People considered attractive, regardless of their gender, tend to be treated more favorably than their less-attractive counterparts.

In his book “Beauty Pays: Why Attractive People are More Successful” economist Daniel Hamermesh contends that good-looking men earn approximately 17% more money than not so good-looking men, while attractive women earn 12% more; as a whole attractive people earn a total of $230,000 more than those considered unattractive (based on average wage of $20 per hour), according to Hamermesh.

While most would respond that “appearance-discrimination” is an unsavory aspect of our society that we should be seeking to transcend, Hakim maintains that erotic capital has been largely ignored because “it is held mostly by women, and the social sciences have generally overlooked or disregarded women in their focus on male activities, values, and interests.”

Yet she also blames feminists for neglecting an opportunity to exploit female erotic capital; feminist theory, she says, encourages women to choose between using their looks and using their intelligence to succeed.

As you might imagine, critics bridle at many of her claims. As Anna North writes on the post-feminist blog Jezebel, “The bottom line is that ‘erotic capital’ is all about others’ perceptions of women, rather than about things women themselves can do or acquire. That’s the main reason ‘soft power’ isn’t real power — because when your influence is based on someone else’s desire, he’s the one who’s really in control.”

I do think Hakim makes some compelling points. Sure, strippers, porn stars, cocktail waitresses and even geishas are financially dependent on their ability to take advantage of their erotic power by making themselves appealing to men. But erotic capital may have subtler effects, too.

Who among us — male or female — hasn’t found that a smile, laugh, and a little harmless flirting can have the potential to open doors, whether that means getting a better table at a restaurant, a raise at work or securing a second date?

And erotic capital isn’t solely the domain of women. “Men now find it necessary to develop their erotic capital as well,” admits Hakim. “They are devoting more time and money to their appearance, work out in gyms to maintain an attractive body, spend more on fashionable clothes and toiletries, and display more varied hairstyles.”

Perhaps they’ve realized that a little erotic capital never hurt anyone. And if the success of the hit male stripper film “Magic Mike” is any indication, women are happy to share the power.
Post by: Ian Kerner Ph.D. – sex counselor
Filed under: Living Well • Sex